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Arku, D. COVID-19 Pandemic on Employee Sleep Quality. Encyclopedia. Available online: https://encyclopedia.pub/entry/19120 (accessed on 06 July 2024).
Arku D. COVID-19 Pandemic on Employee Sleep Quality. Encyclopedia. Available at: https://encyclopedia.pub/entry/19120. Accessed July 06, 2024.
Arku, Daniel. "COVID-19 Pandemic on Employee Sleep Quality" Encyclopedia, https://encyclopedia.pub/entry/19120 (accessed July 06, 2024).
Arku, D. (2022, February 07). COVID-19 Pandemic on Employee Sleep Quality. In Encyclopedia. https://encyclopedia.pub/entry/19120
Arku, Daniel. "COVID-19 Pandemic on Employee Sleep Quality." Encyclopedia. Web. 07 February, 2022.
COVID-19 Pandemic on Employee Sleep Quality
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This entry is adapted from the peer-reviewed paper 10.3390/covid2020012

COVID-19 was declared a pandemic on 11 March 2020, following a rapid, exponential increase in global cases. The COVID-19 pandemic was associated with depression, anxiety, sleep disturbances, distress, and suicidal ideations. This study explored the association of the COVID-19 pandemic and employee sleep quality at a healthcare technology and services organization.

COVID-19 sleep quality quarantine PSQI

1. Introduction

In late December 2019, initial cases of an unfamiliar cause of pneumonia were reported in Wuhan, Hubei Province, China [1]. These cases were subsequently defined as coronavirus disease-2019 (COVID-19) [2][3][4]. COVID-19 was declared a pandemic on 11 March 2020, following a rapid, exponential increase in global cases [5]. As of 29 December 2021, over 280 million global confirmed cases and over 5 million confirmed COVID-19 deaths have been reported, with over 8 billion administered COVID-19 vaccinations [6].
The various quarantine, lock-down, and stay-at-home requirements enacted by international governments to control the spread of COVID-19 resulted in unpleasant psychological experiences [7]. These experiences were postulated to be caused by a feeling of constrained freedom and the absence of effective prophylactic regimens or treatments [7]. Specifically, the COVID-19 pandemic was associated with depression, anxiety, sleep disturbances, distress, and suicidal ideations [8][9][10][11]. Similar experiences were observed in populations afflicted by other epidemics, due in part to feelings of fear and helplessness [7][12][13][14][15][16].
Huang et al. [17] observed the mental health burden on healthcare workers in China during the early stages of the COVID-19 pandemic. Healthcare workers with increased work-related stress were at risk for sleep disorders and reduced sleep quality [17][18]. Qiu et al. [19] and Qi et al. [20] indicated a higher prevalence of sleep disturbances in Chinese medical workers compared to the general population. High-quality sleep is essential to good physical health, as it promotes an optimal immune system and reduces susceptibility to infection [21].

2. Discussion

Findings from this pilot study indicate poor reported sleep quality among employees at one national healthcare technology and services organization in the US at two time points during the COVID-19 pandemic in 2020. These findings align with other international studies that associate the COVID-19 pandemic with worsened sleep quality [22][23]. Further, the data collected, using the PSQI, showed no statistically significant difference in sleep quality among employees at the same organization between July and November 2020.
The mean global PSQI score of 8.61 also indicated poor sleep quality [24] and was comparatively greater than PSQI scores reported elsewhere. For example, one study in China reported a mean PSQI score of 4.88 ± 2.96 among the non-diseased public [22]. In another example, the mean PSQI score among Chinese residents was 4.85 ± 3.11 [23]. However, differences between these studies may be explained by different participant populations and differences between the US and Chinese healthcare systems.
This finding suggests poor sleep quality due to COVID-19 may not be limited to those with direct patient contact in healthcare settings but can affect all employees. Some of these employees might be involved in taskforce committees that are responsible for planning, implementing, and enforcing workplace policies on COVID-19. Hence, this may be associated with their sleep quality. However, other studies observed that the influence of stress on sleep quality, especially among front line employees or employees in patient-facing roles, was higher than in the non-disease public, due to the perceived increased risk of infection among healthcare employees [19][20].
Data from the PSQI found no statistically significant difference in sleep quality between July and November of 2020, which indicates that poor reported sleep quality persisted during the peak of the pandemic in 2020. There may be several explanations for the poor sleep quality observed during the peak of the pandemic in the study. In particular, the US and other countries enacted restrictions to help reduce the spread of this virus [25][26]. Stay-at-home and quarantine orders likely necessitated changes in people’s routines, including the need to: create a makeshift home office environment, deal with work disruptions and distractions, manage childcare and other caring responsibilities, and manage stress from uncertainty about life and insecurity about their health [25][26][27]. The COVID-19 pandemic may have impeded normal sleep patterns due to its impact on anxiety and depression [22][28]. With the high prevalence of insomnia symptoms associated with frequent wakefulness and early awakening during sleep [29], such findings support the notion that the outbreak may have contributed to increasing cases of low sleep quality among the public.
In this project, sleep latency, which measures the time to fall asleep and difficulty to get to sleep within 30 min [24], was among the highest PSQI component scores in both periods. Likewise, sleep disturbances (e.g., waking up in the middle of the night or early morning, or feeling too cold or too hot) [24] was also among the highest PSQI component scores observed in both periods. In our project, most participants reported waking up three or more times per week in the middle of the night or early morning and had difficulty sleeping due to feeling too hot at night. During high temperatures, the body temperature decreases, leading to an increase of the average heart rate and respiratory rate, thus increasing wakefulness [30][31].
To the best of our knowledge, this is the first pilot study of its kind to assess sleep quality in response to the COVID-19 pandemic in the US and adds to the growing interest in the health consequences of COVID-19. To date, efforts to eradicate the virus are projected to continue, given public health initiatives. Further research is needed to assess sleep quality beyond the pandemic recovery phase.
This project had some limitations. First, the cross-sectional measures used in the PSQI only account for responses at one point in time and cannot infer causality. Thus, it may be difficult to identify issues that change frequently, given the unprecedented and unpredictable nature of the COVID-19 pandemic. Sleep quality was only captured among employees at one organization and had a low response rate, even though all eligible participants were invited to participate; thus, the findings may not be generalizable beyond this population. This project did not capture potential confounding risk factors for sleep quality, such as stress, underlying health conditions, anxiety, and depression [11][25]. Data were self-reported rather than obtained from objective assessments (e.g., through polysomnography or actigraphy), and thus sleep quality may have been overestimated or underestimated [32][33]. Additionally, some participants may have a history of frequent poor sleep quality and others may have misclassified their sleep quality due to difficulty in recalling, which could underestimate or overestimate the association. However, if the recall bias is assumed to affect both groups equally, then the effect should be muted.
Future research should adopt a longitudinal study design, recruit a larger and more representative sample, and adjust for potential confounding variables to better assess the impact of COVID-19 on sleep quality. Future research could also evaluate sleep quality in an additional group of healthcare workers who experienced COVID-19 to see how the results compare to the findings of the current study.

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Daniel Arku
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